Meniere’s disease is an inner ear disease of unknown cause, characterized by fluid accumulation in the membranous vagus as the main pathology. Its course is variable, with episodic vertigo, fluctuating deafness and tinnitus as its main symptoms.
[Epidemiology] The incidence of this disease varies widely in the literature, ranging from about 7.5 to 157/100,000. It occurs mostly in young adults, and the peak incidence is between 40 and 60 years old. The incidence rate is about 1 to 1.3:1 in both sexes, and the disease usually develops in one ear, but with the prolongation of the disease, both ears may be involved.
The etiology and pathology of the disease are unknown to date. The main pathological manifestation of the disease is water in the membranous vagus.
The basic pathology is that the membranous vagus is enlarged, and the cochlear canal and balloon are more obvious than the elliptical sac and pot belly.
Clinical manifestations
Typical symptoms of Meniere’s disease include episodic vertigo, fluctuating and progressive deafness, tinnitus, and a feeling of fullness in the ear.
(1) Vertigo: Mostly sudden rotational, patients feel themselves or surrounding objects rotating in a certain direction and plane, or feel chair, lift or float. Vertigo is accompanied by nausea, vomiting, pallor, cold sweat, slow pulse, decreased blood pressure and other autonomic reflex symptoms. Patients are conscious and vertigo lasts for a short period of time, tens of minutes or hours, usually 2h to 3h, and it is rare for vertigo to last more than 24h. During the remission period, there may be a feeling of imbalance or instability, which may last for several days. Vertigo is often recurrent, and the more recurrences it has, the longer it lasts and the shorter the intervals. It has been reported that during the first 20 years of onset, the average number of attacks is usually 6-11 times/year, and after 20 years it is often 3-4 times/year.
(2) Deafness: There may be no conscious deafness at the beginning of the disease, but it becomes obvious after several episodes. It is usually unilateral, worsens during attacks and decreases during intervals, and shows significant fluctuating hearing loss. There are no fluctuations when the hearing loss is mild or extremely severe. The degree of hearing loss decreases with the number of attacks, but rarely is there total deafness.
(3) Tinnitus: It mostly appears before the onset of vertigo. It starts as a persistent low-pitched sound of blowing wind or running water, and then changes to a high-pitched sound of cicadas, whistles or air flutes. Tinnitus increases during vertigo attacks and naturally relieves during intervals, but often does not disappear.
(4) Ear swelling and fullness: there is a feeling of fullness, heaviness or pressure in the affected ear or head during the attack, and sometimes a burning pain around the ear.
Examination
1. Otoscopic examination of the tympanic membrane is normal. Acoustic conductance test is normal. Eustachian tube function is good.
2.Temporal bone CT occasionally shows poor pneumatization around the vestibular aqueduct, and the aqueduct is short and straight.
3, MRI imaging of membrane vagus, some patients can show straight and thin vestibular aqueduct.
4. In vestibular function examination, horizontal or rotational horizontal spontaneous nystagmus and positional nystagmus with different rhythms and intensities, initially to the affected side and then to the healthy side, can be observed or traced with nystagmus electrooculography during the attack period, and the nystagmus shifts to the affected side during the recovery period. The vestibular function of the affected ear may be diminished or lost in multiple recurrences. Hennebert sign (Hennebert sign) is positive when the stapedial pedicle is adherent to the distended balloon.
5. Hearing examination, showing sensorineural deafness, may show sensorineural deafness in those who have had long-term attacks for many years. The -SP of the cochlear electrogram is increased, the SP-AP complex wave is widened, and the -SP/AP ratio is increased (-SP/AP>0.4).
6. Dehydrating agent test The purpose is to detect changes in auditory function by reducing the abnormally increased endolymph and to assist in diagnosis. Glycerol test (glycerol test) is commonly used clinically. The person with this cloth is often positive, but negative in the interval, dehydration and other drug treatment periods. And the hearing damage is mild or severe without fluctuations, the results may also be negative.
Diagnosis and differential diagnosis】The diagnosis of Meniere’s disease mainly relies on detailed history, comprehensive examination and careful differential diagnosis, and the clinical diagnosis can be made after excluding other diseases that can cause vertigo, and a positive glycerol test helps to diagnose this disease.
Diagnosis based on.
1. Episodes of vertigo 2 or more times, lasting from 20 min to several hours. It is often accompanied by autonomic dysfunction and balance disorders without loss of consciousness.
2. Fluctuating hearing loss, mostly low frequency hearing loss in the early stage, with progressive hearing loss gradually aggravated. At least one pure tone audiometry for sensorineural hearing loss, can appear the phenomenon of reverberation.
3.It may be accompanied by tinnitus and/or a sense of ear swelling and fullness.
4.Vestibular function examination: there may be spontaneous nystagmus and/or abnormal vestibular function.
5.Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, vaginitis, vestibular neuritis, drug-induced vertigo, sudden deafness, inadequate blood supply to the vertebral basilar artery and intracranial occupying lesions.
Clinical stages
Early stage: normal hearing or mild low-frequency hearing loss in the intermittent period.
Middle stage: intermittent hearing loss at both low and high frequencies except for 2kHz.
Late stage: full-frequency hearing loss reaches moderate to severe or above, without hearing fluctuation. Medical Education Network collects and organizes
Suspicious diagnosis (Meniere’s disease pending diagnosis)
1.Only 1 episode of vertigo, pure tone audiometry for sensorineural hearing loss, with tinnitus and ear fullness.
2. 2 or more episodes of vertigo lasting from 20 minutes to several hours. Hearing is normal without tinnitus and fullness.
3. Fluctuating low-frequency sensorineural hearing loss. The phenomenon of reverberation may occur. No obvious vertigo attack.
4.Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, vaginitis, vestibular neuritis, drug-induced vertigo, sudden deafness, insufficient blood supply to the vertebral basilar artery and intracranial occupying lesions.
Treatment】 Since the cause and pathogenesis of vertigo are not known, currently most of them are treated with drug combination therapy or surgery mainly to regulate autonomic nerve function, improve inner ear microcirculation, and release vagus fluid.
1.Drug treatment
(1) General treatment: bed rest should be taken during the attack period, and a diet with high protein, high vitamin, low fat and low salt should be used. After the symptoms are relieved, it is advisable to gradually get out of bed as soon as possible. The role of psycho-spiritual treatment should not be ignored.
(2) Symptomatic treatment drugs.
1) vestibular nerve inhibitors
2) anticholinergic drugs
3) vasodilators and calcium antagonists
4) Diuretic and dehydrating drugs.
2. Surgery can be considered in cases of frequent and severe vertigo attacks, long-term conservative treatment and severe tinnitus and deafness. There are many surgical methods, but it is advisable to choose the less destructive surgery that can preserve the hearing first.
(1) Hearing preservation surgery: It can be divided into two subcategories according to whether vestibular function is preserved or not.
1) Vestibular function preservation: including: ① cervical sympathetic ganglion procaine closure; cochlear dialysis with a hypertonic solution containing mannitol through the round window; ② endolymphatic sac decompression; ③ endolymphatic shunt, etc.
2) Vestibular function destruction: ① destruction of the membrane vagus of the vestibule or semicircular canal by electrocoagulation, freezing or ultrasound; ② chemical vestibular destruction; ③ vestibular neurectomy with various approaches, etc.
(2) Non-hearing preservation surgery: i.e. vagotomy.